Use of GIS to support PEPFAR Côte d’Ivoire 2017 PEPFAR Data and Systems Applied Learning Summit Use of GIS to support PEPFAR Côte d’Ivoire September 19, 2017

Context: Data Flow in the Health System Hierarchical structure : Central level 20 health regions 82 health districts, with an average of 4 district per health region (2 to 6 districts /region). About 2,000 public health facilities About half being rural health centers at the lowest level of the health pyramid about 250 urban health centers 4 university hospitals 18 regional hospitals 53 general hospitals 72 district hospitals among others 33 private clinics currently provide ART (44 planned for FY 18) Strategic Centr. Regions (20) Districts (82) Sites (+2,000) Reports compilation & consolidation Feedback /supervision Data aggregation/ some data entry Management decisions Data aggregation/ some data entry Reports Operational Primary data collection forms Date entry/reports

Brief Evolution of Mapping in CI In the beginning of PEPFAR in CI in 2004 (emergency response phase): much less management of sites, areas, or geography Basic use of maps During phase II: Closer look at how partners are operating in the field in order to minimize overlap and look for efficiencies In 2012: Efforts to build more structured GIS database and mapping Who is Doing What, Where Extensive use of GIS mapping to help that process

Key Examples of GIS and Spatial Analysis Use Partners rationalization 2013 COP 14 shifts and COP 15 pivot DHS 2011/2012 results analysis and mapping secondary analysis results Mapping for the Economic Vulnerability Study (ASPIRES) Some advanced spatial analysis and visualizations: Geographical analyses of site level and district level HIV data, including retention patterns, Testing and ART coverage and gaps,… GIS innovation project in FY 18

2013 Partners rationalization process Using GIS to better understand interventions in the field (who is doing what where?) 2013 Partners rationalization process

This is an example of overlapping activities in 2012: difficult to map Geographical challenge: clinical partners by district in 2012 This is an example of overlapping activities in 2012: difficult to map PEPFAR Clinical partners overlapping geographically before 2013 Challenges with GF sites transition

1 clinical partner per district except Abidjan Results of 2013 partner rationalization with GIS Analysis 1 clinical partner per district except Abidjan This helped streamlining, standardizing, and integrating program data for better analysis and decision making There was similar challenge with Community interventions

Using GIS analysis for COP 14 shifts and COP 15 pivot

Analysis based on multivariate analysis at Regional level COP 2014 shifts to Prioritization at Regional Level Scale-up plans in Priority Areas and Populations Analysis based on multivariate analysis at Regional level

COP 2015 pivot: Multivariate analysis of disease burden District categorization for clinical services Example - Map of Percent of PLHIV by district and projected districts to be saturated by FY17, classified by quartile

COP 2015 pivot: Multivariate analysis of disease burden District categorization for clinical services 16 scale-up to saturation districts have 34% of the total disease burden 23 Aggressive scale-up districts have 40% of the total disease burden Together 39 Scale-up districts represent 74% of the disease burden 40 Sustained districts represent 23% of PLHIV

Are we in the right places? Verifying alignment of district prioritization with results every quarter FY 14 FY 16 FY 15

Are we in the right places? Verifying alignment of district prioritization with results every quarter

Identification of low volume ART sites: FY16  Low – High volume ART sites Total number of ART sites 636 Low volume ART sites (<= 25 patients) 196 High volume ART sites (> 1,000 patients) 28

Alignment of OVC programs Collaboration with Global Fund: FY 17 Alignment of OVC programs

DHS 2012-2013 results analysis and mapping secondary analysis results

HIV Prevalence by Region 2005 2012 Increase in Centre-Nord, Nord-Ouest, Ouest et Sud-Ouest regions Decrease in the other regions

Mapping for economic vulnerability study for OVC program (ASPIRES)

Community level mapping: Beneficiary status

Example Map of distance to closest Health Facility for Communities in Bouake

Parallel Coordinates Plot 5. Advanced spatial analysis and visualizations Hotspot Mapping Multivariate visualization and exploratory data analysis Self-organizing map and Multidimensional scaling clustering Charts and Visualizations Self-Organizing Map (SOM) Parallel Coordinates Plot Visualizing individual SNU trends: Visualization of HCT_pos, Care_New and Tx_New Dabou

6. GIS innovation in COP17: Open Geodata Center Objectives: To improve access to HIV services and reach people most at risk To improve understanding of HIV/AIDS program coverage an gaps at community level Support DREAMS like activities (girls roster, map vulnerability, risks, GBV, educational attendance, family planning needs, …) Building data literacy and capacity for data use among the government, Civil Society Organizations, Communities and other stakeholders Promote use of Open data for GOCI Stakeholder engagement, alignment of data sources, hub of collaboration Products Open data Lab Web maps / Story maps Platform for Data analysis &visualization, Dashboards OpenStreeMap Online information resources Intended users: Civil Society Organizations, Communities, Service providers, government, and other stakeholders

6. GIS innovation in COP17: OpenDCH functionality Existing data captured from existing systems such DHIS2, national statistics and surveys and PEPFAR data New data such as OSM in certain areas in Abidjan, San Pedro, Yamoussoukro and Bouake Men’s hotspots DREAMS beneficiaries Data sources Structure of the OpenDCH system: Real-time location of population of interest (men hotspots, girls roster, randomized position of key pop sites,…) Real-time location of HIV services - Services Near You, Service availability, schedules, opening hours, directions to the service point,… Selection of datasets for download Integrated Visualization platform Data Analytics (maps, graphs, …) Advanced analysis based on the policy and program analysis questions Selectable multiple views dashboards for key program indicators Customized reports with selection of location and indicators 23 23

Prototype Web/Story Map for HIV Program Data

Prototype Map Gallery A catalog of all maps produced by the PEPFAR program. Can be viewed by title, date, etc

Prototype Interactive Visualization Selection of a district to view key data elements

Thank You! Questions?